TY - JOUR
T1 - Disparities in outcomes after spine surgery
T2 - A Michigan Spine Surgery Improvement Collaborative study
AU - Macki, Mohamed
AU - Hamilton, Travis
AU - Lim, Seokchun
AU - Telemi, Edvin
AU - Bazydlo, Michael
AU - Nerenz, David R.
AU - Zakaria, Hesham Mostafa
AU - Schultz, Lonni
AU - Khalil, Jad G.
AU - Perez-Cruet, Miguelangelo J.
AU - Aleem, Ilyas S.
AU - Park, Paul
AU - Schwalb, Jason M.
AU - Abdulhak, Muwaffak M.
AU - Chang, Victor
N1 - Funding Information:
Dr. Khalil: direct stock ownership in Medtronic, NuVasive, and Johnson & Johnson; consultant for Stryker, Medtronic, Camber Spine, Centinel Spine, and Relievant Medsystems; and clinical or research support for the study described from Stryker, Medtronic, Johnson & Johnson, Centinel Spine, Relievant, Limiflex, and Fzi-omed. Dr. Perez-Cruet: ownership in Thompson MIS. Dr. Park: consultant for Globus and NuVasive; royalties from Globus; and support of non–study-related clinical or research effort from ISSG and DePuy. Dr. Schwalb: support of non–study-related clinical or research effort from Medtronic, StimWave, and Neuros; consultant for BlueRock and Guidant; and salary support for role as co- director of MSSIC (paid directly to Henry Ford Health System). Dr. Abdulhak: consultant for SeaSpine and Ulrich Medical. Dr. Chang: consultant for Globus Medical, K2M, and SpineGuard; and research funding from Medtronic. Although Blue Cross Blue Shield of Michigan (BCBSM) and MSSIC work collaboratively, the opinions, beliefs, and viewpoints expressed by the authors do not necessarily reflect the opinions, beliefs, and viewpoints of BCBSM or any of its employees. Support for MSSIC is provided by BCBSM and Blue Care Network as part of the BCBSM Value Partnerships program.
Publisher Copyright:
© 2021 AANS.
PY - 2021/7
Y1 - 2021/7
N2 - Objective: Most studies on racial disparities in spine surgery lack data granularity to control for both comorbidities and self-assessment metrics. Analyses from large, multicenter surgical registries can provide an enhanced platform for understanding different factors that influence outcome. In this study, the authors aimed to determine the effects of race on outcomes after lumbar surgery, using patient-reported outcomes (PROs) in 3 areas: The North American Spine Society patient satisfaction index, the minimal clinically important difference (MCID) on the Oswestry Disability Index (ODI) for low-back pain, and return to work. Methods: The Michigan Spine Surgery Improvement Collaborative was queried for all elective lumbar operations. Patient race/ethnicity was categorized as Caucasian, African American, and "other."Measures of association between race and PROs were calculated with generalized estimating equations (GEEs) to report adjusted risk ratios. Results: The African American cohort consisted of a greater proportion of women with the highest comorbidity burden. Among the 7980 and 4222 patients followed up at 1 and 2 years postoperatively, respectively, African American patients experienced the lowest rates of satisfaction, MCID on ODI, and return to work. Following a GEE, African American race decreased the probability of satisfaction at both 1 and 2 years postoperatively. Race did not affect return to work or achieving MCID on the ODI. The variable of greatest association with all 3 PROs at both follow-up times was postoperative depression. Conclusions: While a complex myriad of socioeconomic factors interplay between race and surgical success, the authors identified modifiable risk factors, specifically depression, that may improve PROs among African American patients after elective lumbar spine surgery.
AB - Objective: Most studies on racial disparities in spine surgery lack data granularity to control for both comorbidities and self-assessment metrics. Analyses from large, multicenter surgical registries can provide an enhanced platform for understanding different factors that influence outcome. In this study, the authors aimed to determine the effects of race on outcomes after lumbar surgery, using patient-reported outcomes (PROs) in 3 areas: The North American Spine Society patient satisfaction index, the minimal clinically important difference (MCID) on the Oswestry Disability Index (ODI) for low-back pain, and return to work. Methods: The Michigan Spine Surgery Improvement Collaborative was queried for all elective lumbar operations. Patient race/ethnicity was categorized as Caucasian, African American, and "other."Measures of association between race and PROs were calculated with generalized estimating equations (GEEs) to report adjusted risk ratios. Results: The African American cohort consisted of a greater proportion of women with the highest comorbidity burden. Among the 7980 and 4222 patients followed up at 1 and 2 years postoperatively, respectively, African American patients experienced the lowest rates of satisfaction, MCID on ODI, and return to work. Following a GEE, African American race decreased the probability of satisfaction at both 1 and 2 years postoperatively. Race did not affect return to work or achieving MCID on the ODI. The variable of greatest association with all 3 PROs at both follow-up times was postoperative depression. Conclusions: While a complex myriad of socioeconomic factors interplay between race and surgical success, the authors identified modifiable risk factors, specifically depression, that may improve PROs among African American patients after elective lumbar spine surgery.
KW - African American
KW - Disparity
KW - Lumbar
KW - Race
KW - Satisfaction
UR - http://www.scopus.com/inward/record.url?scp=85109142498&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85109142498&partnerID=8YFLogxK
U2 - 10.3171/2020.10.SPINE20914
DO - 10.3171/2020.10.SPINE20914
M3 - Article
C2 - 33962387
AN - SCOPUS:85109142498
SN - 1547-5654
VL - 35
SP - 91
EP - 99
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
IS - 1
ER -